How the Centers for Medicare & Medicaid Services is attempting to save the Individual Market.

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On April 13, the Centers for Medicare and Medicaid Services (CMS) released the final Market Stabilization rule with hopes to lower premiums, stabilize the Exchange and the individual health insurance market.  Here are five key takeaways you need to know:

 

1.  2018 Open Enrollment Period

The standard 90-day Open Enrollment Period will be shortened to a 45-day window in 2018. The next Open Enrollment Period will start on November 1, 2017 and end on December 15, 2017.

Anyone applying for coverage during Open Enrollment Period will be issued an effective date of January 1, 2018.

2.  Special Enrollment Periods

There will be no more honor system when applying for coverage during Special Enrollment Period.  The Exchange will require supporting documentation to verify a Qualifying Life Event did indeed occur.

3.  Unpaid Premiums

Insurance companies will be permitted to collect unpaid premiums from the previous year if an individual wants to enroll in coverage with the same insurance company the following year.

This is intended to prevent the number of people who avoid making premium payments during the last few months of the year unless they get sick.

4.  More Plan Choices 

There will be more flexibility in achieving actuarial values relative to metallic tier status. This should permit more plan choices, but we ’ll have to wait and see how many insurance companies continue to participate in the Exchanges and the individual marketplace.

5.  Network Adequacy

States will have the power to determine if plan networks are adequate and have enough doctors and hospitals for individuals to receive medical care—not the federal government.